I don’t have very many readers here at Fat in the Fire so when one of them emails me with a suggestion, I feel it’s a good idea to pay attention. When that reader is herself a well-known and well-respected blogger and freelance writer, I think it’s a good idea to take her suggestion seriously. This morning I had an email from L-girl who has been wading through my amateur posts. She isn’t clear on why I don’t want a hysterectomy and asked me to direct her to a post or posts where I explain myself. Turns out this is not such an easy task. I’ve gone back and looked at some of those posts and it looks like I muddled all around the subject but never really came right out with it.

I made vague references to some on-line research and negative after-effects here. Then I read this book–which is a horror of pain, misery, and sloppy surgeries. I tried to make the point that too many women do not take part in the decision-making process but rather turn over their power to doctors who do not always tell them the whole truth. I referenced another article about long-term after-effects here.

A reputable Canadian source, the Ontario Women’s Health Council, released this report in 2002. I blogged about it, as it applies to me here. According to this report, hysterectomy is used too often as the only treatment for a number of ailments. for my diagnosis, endometrial hyperplasia, the first line treatment should be hormone therapy, not hysterectomy.

The studies say that chronic depression often follows a hysterectomy–especially when the ovaries are removed. Well, I’m already at risk for Depression, having suffered a big one (1997-1999.) I’m not looking for another for another visit to the Pit of Despair. Loss of libido is another big problem for me. We’ve only been married three years. We love each other very much and we enjoy a pretty fantastic sex life. I really don’t want to lose that; it just isn’t fair to either of us to throw that away without a fight. The whole idea of allowing myself to be castrated (and I am talking about removal of the ovaries here) is problematic for me. Unless someone can tell me why the ovaries need to be removed then I’m not allowing it–and same goes for the cervix.

Now, if many women who have hysterectomies have a lower quality of life following the surgery, and if the progressive thinking is that many hysterectomies are unnecessary to begin with, then I am not going to just lie down, as it were, and allow it to be done to me without asking some serious questions and insisting on some thorough answers. I intend to be an active partner in my own treatment.

To further illustrate the idea of taking part in one’s own treatment, read this piece by Stefanie Weiss in the Washington Post. In it she talks about how her own gynecologist insisted she needed an abdominal hysterectomy to remove her large fibroids. After much research and insistence, she discovered that a laparoscopic option was available. Her doctor insisted on the more invasive procedure, not because it was better for the patient, but because the doctor did not know how to perform that laparoscopic procedure herself. In the end, Ms. Weiss chose the laproscopic procedure, had it done by another surgeon and had a 2 day recovery period as opposed to a six-week recovery.

When I went to the OB/GYN I had some abnormal bleeding. She performed a D & C on me, which was successful in elimination that bleeding. I had a couple regular periods afterward without the constant spotting. Of course, then we, my family doctor and I, meddled with it by trying the Tri-Cyclen for a month and then I went on to the Progesterone (with Dr. Pettle) things have not been so simple lately, but I’m not having the constant bleeding or spotting any longer. I’m not in any pain. I actually have no untoward symptoms at all. I have no fibroids; I have no cysts on my ovaries; thus far, no one has indicated any problematic tissue on my cervix. (I’ll have to wait awhile to hear the results of the Pap done last month.)
Conversely, I have corresponded with women who have been in terrible pain from their periods, who lost so much blood they were constantly anemic. They were physically and emotionally exhausted by the constant pain and the disruption to their lives. I corresponded briefly with a very young woman who needed an emergency hysterectomy following the birth of her child. It was done to save her life. These women needed hysterectomies and I support them and hope for their full recoveries. But that is not my situation. Not at all.

In my situation, the doctor took a small, a very small, sample of tissue from inside my uterus; the pathology report indicated a small number of atypical cells. It is possible, as in not entirely out of the question, that these atypical cells might, at some point become cancerous. (Or, as the surgeon/oncologist pointed out, (might already be cancerous.) The conservative viewpoint says that if that possibility exists AT ALL, the uterus should be removed. this is also in line with the surgeon’s credo “When in doubt, cut it out.”

The more progressive, and less invasive, treatment calls for a treatment with progesterone for four to six months, a repeat biopsy and if necessary another round of progesterone at higher dosage. This causes a shedding of tissue and a thinning of the uterine lining in which the offending cells are sloughed off. It takes longer, it’s less certain of an outcome but it is non-invasive and if necessary the hysterectomy can be done in the future.

A completely different point of view exists in the Naturopathic community. There it is theorized that the hyperplasia is a normal part of the aging process. They look at the statistic that 75% of the cases of endometrial hyperplasia reverse themselves through menopause without any medical intervention whatsoever and advocate nothing more than a watchful eye. In the interest of full disclosure, I haven’t actually researched this myself; this information comes from a friend who is a midwife.

In any case, I cannot understand why the ovaries and cervix need to be removed as well; when I quizzed the doctor about it, she could not, or would not provide me with any explanation. Before I sign any consent form, someone will need to make their case and make it very well. The fact that I no longer need ovaries “for childbearing reasons” is a non-starter. Ovaries don’t just stop working one day; they continue to provide estrogen for several years post-menopause and I want them.

To be clear: NO, I don’t want a hysterectomy–if it can be avoided But, if the other treatment option fails and I do need a hysterectomy, I would rather it was as minimally invasive as possible so I would rather not have the open abdominal procedure AT ALL. I would rather keep my ovaries and cervix if possible. Above all, I do not want to be rushed into an irreversible surgery without exploring every possible option. Having said that, if some medical professional can bring me a definite diagnosis of cancer and can explain to me why I must part with my ovaries and cervix and why the surgeon needs to make a six inch vertical incision in my abdomen in order to save my life, then and only then will I sign the consent form, but I will do it knowing I’ve made the right decision.